Prognostic value of a new electrocardiographic method for diagnosis of left ventricular hypertrophy in essential hypertension.
OBJECTIVE
We tested the prognostic value of a new electrocardiographic (ECG) method (Perugia score) for diagnosis of left ventricular hypertrophy (LVH) in essential hypertension and compared it with five standard methods (Cornell voltage, Framingham criterion, Romhilt-Estes point score, left ventricular strain, Sokolow-Lyon voltage).


BACKGROUND
Several standard ECG methods for assessment of LVH are used in the clinical setting, but a comparative prognostic assessment is lacking.


METHODS
A total of 1,717 white hypertensive subjects (mean age 52 years; 51% men) were prospectively followed up for up to 10 years (mean 3.3).


RESULTS
At entry, the prevalence of LVH was 17.8% (Perugia score), 9.1% (Cornell), 3.9% (Framingham), 5.2% (Romhilt-Estes), 6.4% (strain) and 13.1% (Sokolow-Lyon). During follow-up there were 159 major cardiovascular morbid events (33 fatal). The event rate was higher in the subjects with than in those without LVH (all p < 0.001) according to all methods except the Sokolow-Lyon method. By multivariate analysis, an independent association between LVH and cardiovascular disease risk was maintained by the Perugia score (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.5 to 2.8) and the Framingham (HR 1.91, 95% CI 1.1 to 3.2), Romhilt-Estes (HR 2.63, 95% CI 1.7 to 4.1) and strain methods (HR 2.11, 95% CI 1.4 to 3.2). The Perugia score showed the highest population-attributable risk for cardiovascular events, accounting for 15.6% of all cases, whereas the Framingham, Romhilt-Estes and strain methods accounted for 3.0%, 7.4% and 6.8% of all events, respectively. LVH diagnosed by the Perugia score was also associated with an increased risk of cardiovascular mortality (HR 4.21, 95% CI 2.1 to 8.7), with a population-attributable risk of 37.0%.


CONCLUSIONS
The Perugia score carried the highest population-attributable risk for cardiovascular morbidity and mortality compared with classic methods for detection of LVH. Traditional interpretation of standard electrocardiography maintains an important role for cardiovascular risk stratification in essential hypertension.
Verdecchia
P
P
Area Omogenea di Cardiologia e Medicina, Ospedale R. Silvestrini, Perugia, Italy. verdec@tin.it
Schillaci
G
G
Borgioni
C
C
Ciucci
A
A
Gattobigio
R
R
Zampi
I
I
Porcellati
C
C
D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology; D016001:Confidence Intervals; D003327:Coronary Disease / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology
D000959:Antihypertensive Agents